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ACA Repeal Options Would Weaken Access to Substance Use Treatment

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House Republicans’ policy alternatives to the Affordable Care Act (ACA) would cut federal Medicaid funding and end the ACA’s Medicaid expansion for low-income adults, among other things. That would put millions of people’s coverage for substance use disorder services at risk even as deaths due to opioid use are rising in many states, especially in rural areas.

As Republican Governor John Kasich of Ohio — a state that’s adopted the expansion — recently said of Republican proposals to eliminate it:

There are 700,000 Ohioans who now get care who didn’t have it before, a third of whom have either mental illness and need to be treated or drug addiction, which is a problem throughout the country. A quarter of them have chronic conditions. They don’t even know it. And to turn our back on them makes no sense. . . .

The ACA expanded health insurance eligibility and affordability for people with substance use disorders, including opioid addiction, and it ensures that health insurance comes with the right benefits to cover necessary treatment and services. One result is that Medicaid can now cover the cost of services like medication-assisted treatment, detoxification centers, and drug rehabilitation facilities, which makes them affordable for low-income people.

Undermining Medicaid coverage for substance use treatment would dampen the hope for recovery that treatment can provide. As Chad Diaz, a 36-year-old New Hampshire resident who began using heroin at age 12 and is now using medication, covered by his health insurance, to overcome his addiction, told the New York Times, “If [health coverage] gets taken away from me, it’s right back to Square 1, and that’s not a good place.”